应用球囊漂浮电极导管心脏临时起搏的临床观察

Clinical study of temporary cardiac pacing using balloon-tipped floating catheter

目的 对经应用漂浮电极导管行床旁心脏临时起搏的病例进行总结分析 ,探讨床旁心脏临时起搏的方法学和可行性。方法 对 5 13例因多种心律失常需要临时起搏的患者应用球囊漂浮电极导管进行心脏临时起搏 ,通过分析起搏心电图图形特点和测量导管深度 ,并对需要植入永久起搏器的12 6例患者的X线胸片进行研究 ,判定该起搏方法的可行性和成功率 ,分析起搏失败的原因。结果 床旁心脏临时起搏适用于各年龄组人群 ,起搏部位主要为右心室心尖部和流出道两种。经左锁骨下静脉入路植入者 ,两种起搏点的导管深度分别为 (37 5 3± 3 5 2 )cm和 (34 2 1± 3 15 )cm ,右心室流出道起搏感知不良的发生率较心尖部高 (P <0 0 1) ,两组间起搏阈值差异无显著性。通过起搏心电图图形和导管深度指导下应用漂浮电极导管即刻起搏成功率高达 99 6 1% ,并发症发生率小于 1%。结论 体表心电图和导管深度指导下应用顶端球囊漂浮电极导管进行心脏临时起搏是一项安全有效、可行的起搏方法 ,只要操作方法正确 ,几乎可取代X线指导下的临时起搏 ,值得临床推广。

Objective The purpose of this study is to investigate the methodology and feasibility of bedside temporary cardiac pacing with balloon tipped floating catheter. Methods Five hundred and thirteen patients in this study were treated with bedside temporary cardiac pacing for arrhythmias. A balloon tipped floating catheter was inserted through the left subclavine vein in right ventricle, guided by the length of catheter in body and the QRS morphology of pacing electrocardiogram(ECG). After that, the pacing site was identified by X ray fluoroscopy in 126 patients. Then, the feasibility and successful rate of this bedside temporary cardiac pacing, and the causes for failure were analyzed. Results Guided by the length of catheter and the QRS morphology of pacing ECG the successful rate of balloon tipped floating catheter putted into right ventricle was 99.61%. The most successful pacing sites were located at the right ventricular apex(RVA) and right ventricular outflow tract. The lengths of catheter from the puncture sites to RVA and right ventricular outflow tract(RVOT)were (37.53±3.52)cm and (34.21±3.15)cm, respectively. Incidence of undersensing in RVOT pacing group was significantly higher than that in RVA pacing group( P <0.01). However,there was no significant difference in pacing threshold between these two groups. The rate of complication was less than 1%. Conclusion Guided by the length of catheter and QRS morphology of pacing ECG, the balloon tipped floating catheter can be safely used for bedside temporary cardiac pacing for patients with different age with a high successful rate.